A finding that struck me from the survey conducted in Blantyre, Malawi concerned HIV-related stigma and family dynamics. It reported that 68% of women compared to 36% of men would want to keep it a secret if a family member had HIV. In the discussion, they mildly conclude that women are more discriminatory than men when it comes to stigma and discrimination of HIV.

I disagree that women in Malawi are more discriminatory. From my research on gender in Blantyre and the observations I made during my limited experience there, I think there is an alternative reason for why women more than men would want to keep it a secret if a family member was infected with HIV. Women to me seem more socially connected, more relational with their neighbors, friends, and other mothers, in very personal and familial social networks: the neighborhood, the local church, their children’s schools, the market. In this sense women seemed to be more tightly woven into the fabric of other people’s lives. So something like stigma against a family member who has HIV is more damaging, more threatening, more immediate to a wife or a mother in Blantyre.

Women then, are not more discriminatory. Rather, they are more affected, threatened, or harmed by discrimination from their community. The conclusion drawn from the MICS seems to conflate women being more discriminatory with women being more susceptible to discrimination.

“We tell ourselves that pestilence is a mere bogy of the mind, a bad dream that will pass away. But it doesn’t always pass away and, from one bad dream to another, it is men who pass away.”
-Albert Camus, The Plague

Last weekend my internet and cable went out in my apartment, so I spent most of Saturday and Sunday lying on the couch with the windows open, reading The Plague. I have to write an essay for my Ethical Issues in Public Health class on the “strengths and weaknesses of utilitarianism and contractarianism or rights theory in public health ethics,” built around a reading of one of several books, of which I chose the novel by Albert Camus. This isn’t the essay… just a story and some thoughts…

Shortly after I returned home from Eldoret, a street boy I knew was killed. He was traveling between Eldoret and Nairobi, presumably in search of greater economic opportunity in the big city. As many street children do, his mode of travel was to hang onto the undercarriage of trucks carrying goods between these two urban centers. The roads are bad enough that trucks travel slow enough such that street children can hang onto the chassis for a few kilometers, hop off when they grow tired, then climb back on to travel further down the road. Somewhere along the road, he lost his grip. Caught under the wheels, he was killed instantly. A mere street boy, he was quickly forgotten. An orphan of poverty, in search of money, food, friendship, and family… the road cut short his journey. He was 12.

Shortly after Christmas, as the world began a new year, violence erupted on the streets of Kenya. Poverty, tribalism, corruption and shattered hope created the context for killing. Former neighbors turned into enemies. Historical tribal tensions were re-ignited under a new pretext of politics, burning violently to the surface. “The whole country was on fire” several of my friends told me, recalling the horrifying months of January and February. Poverty, the pit holding the fire, quickly deepened. In total, 1,133 Kenyans died and thousands are still displaced, living in camps. Blood stained many hands.

Many of us subscribe to utilitarianism superficially. The greatest good for the greatest number. It sounds very appealing. But would you allow a single person to die in order to save ten? Instead we believe ourselves to be inherently worthy and equal as individuals, regardless of our “utility”, everyone sharing a right to life, to prosperity, to well being, to health… And releasing us from egoism, we live within a social contract. It is not only our own right that we must ensure; we have a responsibility to ensure that other’s rights are upheld as well. By upholding each invidual’s right to life, and recognizing we are inextricably connected to every other person in this world, we collectively share the moral burden of ensuring every person’s rights, without having to sacrifice anyone…

Kenya is a poor country, with a tenuous, and short, history of democracy. There is much work to be done with big development strides to make, and with this comes the possibility for great hope and achievement upon electing a new president, and also the bitter anger and sense of betrayal if the democratic process is taken away from you. In Kenya, there are bad roads, unregulated laws, families living without enough to eat, children out of school and out of home, living a life on the streets in search of food, income and meaning. Born into circumstance, as we all are, the boy who died was living the reality of having to travel between Nairobi and Eldoret hanging onto the undercarriage of trucks. Because of this, he died. I knew him, interviewed him, talked with him, have his picture on my computer. You are now reading about him. He, and others like him—other street children in Eldoret; the poor, the marginalized, the vulnerable, the oppressed, the unlucky no matter the geography—are our responsibility. We abide, or must abide, by a social contract that both guarantees and takes responsibility for their rights… to life, to prosperity, to well being, to health…

Poverty is not a bogy of the mind, not a bad dream that will pass away. It is our responsibility. Indeed, men are passing away because of it.

When I was in Eldoret, a crew from Sky1, a news channel/service in the UK, came to do a piece about children displaced after the post-election violence. The British NGO, Save the Children, is working in Eldoret to this end. What Sky1 found was the large population of street children in Eldoret, making their way through life on the streets, heavily addicted to glue, marginalized, impoverished, vulnerable, without education or family support. The name they used, “The Glue Kids”, kind of makes me cringe — b/c I have pictures of most of these kids on my computer, along with their personal testimonials, and tried all summer to know them by name, as real children — however, it is wonderful that a news agency like this has shown concern and is spreading the message to the world that these children exist and need our help.

Between 20 and 30 street children wait patiently for me each morning. I wake up early, take a bicycle taxi into town, stop by the supermarket to buy bread, butter, milk, sugar, and tea, then walk to the Ex-Street Children Community Based Organization where we serve breakfast and interview each street child as part of my research study to learn first-hand about their backgrounds, survival mechanisms, drug use patterns, and perceived barriers to leaving the streets. Many come to the office day after day, know me by name, some even meeting me half way to help carry the grocery bags. Others are new faces, recruited by their street peers to come receive a free breakfast, play checkers, do puzzles, draw pictures, and share their life stories with the hope that someone, finally, will do something to help them and their families. We conducted 70 interviews, without a single refusal, and as a result came up with a fairly comprehensive picture of the causes and consequences of street life in Eldoret, Kenya.

By partnering with this community based organization to conduct the research, we created a safe place for street children to come off the streets each day. This in and of itself may have been the most important conclusion of our study–the very simple realization that street children NEED a safe, physical space OFF the streets, where they can eat, play, share their stories, interact in a positive social environment, escape stigmatization, discrimination, and abuse, access services… even just have a place to sleep.

Coming back to the office from a meeting in town one afternoon and witnessing these children laying underneath the table, sleeping peacefully on top of each other, I was overtaken by the importance they placed on having a safe place off the streets where they could come to escape the harsh realities of their daily existence. The near unanimous answer to the question, “What is the hardest part of living on the street?” was, harassment and abuse by police, and beatings and theft from the older street boys. Street children are quite possibly one of the most marginalized and vulnerable populations in the world, and although they are absolute masters of survival, they are still children who need protection and support. There are 150 million street children worldwide, a couple thousand in Eldoret, and nothing has proven to me more that they need our help than this picture, taken long after breakfast was served and our interviews were completed. Walking away from this non-verbal scream for help, can no longer be an option.

“To feel high”; “to be able to sleep outside”; “to get happiness”; “to feel warm during the cold, especially at night”; “to not feel so hungry”; “to forget my problems”; “when someone does something wrong to me to have no fear and fight”; “to relieve stress and anxiety”; “to have courage to rob someone”; “because my friends influenced me”

Asking street children in Eldoret the question, “Why do you use?” these are several of the more common responses I get. Their drug of choice? Huffing glue. And although I haven’t fully completed the analysis, of 50 street children I’ve interviewed, I would say only about 5 said they don’t use glue. Nearly all started using glue immediately when they came to the streets, and most use every day, all day. They buy the glue from cobblers or small supply shops in town, and a whole days worth of glue costs 20 shillings at most (about 30 cents). Street children may lack obvious material needs and basic human rights – food, clothing, shelter, education, and health care – but their addiction to glue makes the seemingly simple provision of these lacking needs very difficult. In my mind, and the mind of many others I’ve talked to here, drug use among street children represents the single biggest barrier to finding lasting solutions.

“He said, nobody else ever loved him / that’s why he get high enough to go touch the heaven’s above him / vividly remembers every pipe every needle that stuck him / every alley he ever slept in every purse that he snuck in / every level of hell he’s been to and the one that he’s stuck in / the one he can’t escape, even though it’s of his own construction / maybe you can’t relate, maybe you one of those that just doesn’t / maybe he doesn’t care, loves to allow these demons to come in with No… Intruder… Alert”
-lupe fiasco (Intruder Alert, from The Cool)

The pungent smell of chang’aa stings my nostrils as we push back the lace cloth covering the door. Inside a large bucket sits on the only table, from which 10 shilling cups of the home-brewed maize liquor are served; served to men who waste their days sitting and drinking to complete incoherence and oblivion; served by women who make their living brewing, hoping to earn enough at the end of each day to feed their children, and if they’re lucky, send them to school. This area of Langas is called Kambingurewe, kambi- meaning slum or village, and -ngurewe meaning a place where pigs are kept. The name seems ironically fitting. It is a large brewing area, where woman after woman brews and sells chang’aa, and in two consecutive rooms of one of the long, mud-wall rental houses, two single mothers qualify to participate in my research study. They qualify because both have children in their household who rather than going to school, go to the streets.

“I don’t know why they go to the street” both mothers tell me when I ask them the “Why” questions. They explain that there is enough to eat at home and primary education is free in Kenya. Indeed, there is enough food at home—both mothers are HIV+ and poor, and are therefore receiving food from AMPATH’s nutrition program. And indeed, primary education is free in Kenya, but the uniforms are not; neither are the books, the pens, the notebooks, the exam fees, the registration fees, sometimes not even the desks. But there is a more pervasive, and much more obvious reason why these children are on the street—the youngest son of one mother, and 4 younger siblings of the other sister who is head of the household, and a mother of a young baby herself. And that reason is continuing to sting my nostrils. The environment these kids have grown up in is simply not the kind of environment where one can have a pleasant, normal childhood, going off to school each morning and returning home to do your homework each night.

Should the mothers be blamed for raising their children in a “bad” environment? I find it extremely hard to place any sort of blame on people attempting to survive in extreme poverty. These mothers, supporting 10 and 6 in their respective households, wake up every day to begin brewing so that they can earn a couple hundred shillings. Their biggest expense is paying the almost daily bribe to the different police officers who come each day. Brewing chang’aa is “illegal” in Kenya, but the police manage the brewing areas in the slums more like personal businesses. The police come so frequently that each woman in the area takes her turn paying the bribe by borrowing from the other women, and then pays them back throughout the week, or just loans the money when it is someone else’s turn to pay the bribe.

We had to arrive early to conduct the interviews because by late morning the women were busy serving chang’aa, and we’d rather avoid questioning by drunk and stumbling old men. Although it was before 10am, as we were conducting the interview in the second home, a man walks in looking about 70 but probably only 50, cigarette in his hand, eyes glazed, wanting his first 10 shilling cup of the day. I was nearly sick to my stomach. The smell was overwhelming. The old man wanting this nasty alcohol was overwhelming. The mud floor, single bed, tattered mosquito net, few scattered dishes and dirty cooking pots were overwhelming. The small baby, half-naked, unable to breastfeed because his mother was HIV+, likely to grow up in this same environment where 4 of his older siblings had “chosen” life on the streets over life at home and in school was overwhelming. The man was told to wait, crushed out his cigarette on the floor, turned and ducked out the door; I regained focus and resumed the interview.

During the first interview, the older sister to the mother waked in briefly to say hi, and we learned that she too had a boy who went to the street. I was no longer surprised. She lived about 10 feet around the corner, and was also a brewer. We went to visit her after finishing the two interviews and began chatting about her son who was now a street boy. In the middle of our conversation, one of her young daughters, still clad in her school skirt and sweater, poked her head in the door and hurriedly chattered something in Swahili. At the end I picked up the word “polisi” and realized many of these young children act as scouts for their mothers’ illegal brewing business. Immediately, the mother jumped up from her seat, and with no goodbyes, no words, no nothing, she rushed into the kitchen and began frantically covering sufurias filled with chang’aa. Samuel, Virginia, Veronicah, and I all looked at each other wondering what to do. “I’m not dealing with the police,” Virginia said to me. “I’m not either,” I quickly returned. And with that, we jumped up and walked quickly out the door, and out of kambi nguruwe.